Medical pluralism and livestock health: ethnomedical and biomedical veterinary knowledge among East African agropastoralists

Narratives of veterinary drug use in northern Tanzania and consequences for drug stewardship strategies in low-income and middle-income countries

INTRODUCTION

Awareness-raising campaigns play a central role in efforts to combat drug resistance. These campaigns assume that knowledge deficits drive poor practices that increase resistance. Therefore, increasing awareness will promote prudent practices and reduce resistance. However, most awareness campaigns have been developed and evaluated in high-income and public health settings. Consequently, it is not clear whether these campaigns are effective in low-income and middle-income countries and/or within animal health settings.

METHODS

Focus group discussions and in-depth interviews were used to collect narratives of veterinary drug use among Maasai pastoralists (n=70), animal health professionals (n=10) and veterinary drug sellers (n=5). Thematic analysis was used to identify recurring themes across narratives and groups.

RESULTS

Narratives of Maasai and animal health professionals indicated that Maasai treated their livestock with limited input from the professional sector and that non-prudent treatment practices were observed (eg, using antimicrobials as 'energizers'). Professionals linked these practices to knowledge and attitudinal deficits among the Maasai, while Maasai narratives highlighted the importance of climatic uncertainties and cultural beliefs surrounding veterinary care.

CONCLUSION

Narratives of veterinary drug use from animal health professionals are consistent with the knowledge deficit assumption guiding awareness-raising efforts. In contrast, Maasai narratives highlight how animal health practices are patterned by cultural norms interacting with factors largely outside of Maasai control, including a constrained professional veterinary sector. If these cultural and structural contexts remain unconsidered in awareness-raising strategies, current campaigns are unlikely to motivate practices necessary to limit drug resistance, especially within low-income and middle-income settings.

Conventional knowledge, general attitudes and risk perceptions towards zoonotic diseases among Maasai in northern Tanzania

Understanding factors influencing conventional medical knowledge (CMK), general attitudes and risk perceptions of zoonotic diseases among rural residents who face risk of exposure to such diseases is important for human, livestock, and wildlife health. Focusing on Maasai from Makame, Kiteto District (Tanzania) who largely maintained a semi-nomadic lifestyle, we evaluated respondents’ CMK of causes, symptoms, treatments, and prevention methods of rabies, brucellosis, and anthrax. In addition, we identified socio-demographic correlates of CMK with respect to the target zoonoses. Finally, we assessed the relative frequency of practices that increase the risk of pathogen transmission, and compared the risk perception of the three diseases. We conducted structured interviews with Maasai respondents (n = 46) in six sub-villages of Makame and considered education, gender, age, and wealth (indicated by standardized number of livestock) as potential correlates of CMK. Respondents had greater CMK of rabies and anthrax, but feared anthrax the most. Receiving formal education increased rabies CMK (p ≤ 0.05). The CMK of anthrax and brucellosis was not associated with any of the tested variables (p > 0.05). Risk perceptions were correlated with knowledge scores for rabies and anthrax (p ≤ 0.05), and multiple interviewees reported engaging in practices that potentially enhance pathogen transmission. Specific socio-demographic attributes (i.e., formal education) may explain the observed variation in CMK of zoonotic diseases. This information can be used to develop and tailor health education programs for specific at-risk groups.

"We are doctors": Drivers of animal health practices among Maasai pastoralists and implications for antimicrobial use and antimicrobial resistance

Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.

Knowing Is Not Enough: A Mixed-Methods Study of Antimicrobial Resistance Knowledge, Attitudes, and Practises Among Maasai Pastoralists

Global, national, and local efforts to limit antimicrobial resistance (AMR) often stress the importance of raising awareness among users, sellers, and prescribers of antimicrobial drugs. This emphasis is founded upon two assumptions. First, awareness is limited, particularly concerning the links between antimicrobial use (AMU) and AMR. Second, "filling the awareness gaps" will motivate practises that will limit AMR. The first assumption is supported by knowledge, attitudes, and practises (KAP) surveys but these same studies provide mixed support for the second, with several studies finding that knowledge and attitudes are not correlated with related practises. This disconnect may arise as these surveys typically do not collect data on the cultural or historical contexts that pattern AMU. To explore how these contexts impact KAP related to AMU and AMR, we use a mixed-methods approach to examine veterinary practises among Maasai pastoralists in Tanzania. We combine a quantitative KAP survey (N = 195 households) with extensive qualitative data from focus group discussions (N = 55 participants). Results document limited awareness of AMR but also find that knowledge and attitudes are not correlated with practise. Thematic analysis of qualitative data pointed to three reasons behind this disconnect, including (1) Maasai self-perceptions as veterinary experts, (2) the central role of livestock in Maasai culture, and (3) the use of ethnoveterinary knowledge in animal health treatment. We argue that mixed-method approaches will be critical to developing the targeted awareness campaigns needed to limit the emergence and transmission of AMR.

An ethnoveterinary study on medicinal plants used by the Buyi people in Southwest Guizhou, China

BACKGROUND

The Buyi (Bouyei) people in Qianxinan Buyi and Miao Autonomous Prefecture, Southwest Guizhou, China, have used medicinal plants and traditional remedies for ethnoveterinary practices, such as treating domestic animals during livestock breeding, since ancient times. However, the unique ethnoveterinary practices of the Buyi have rarely been recorded. This study aimed to identify the plants used in their traditional ethnoveterinary practices, and to propose suggestions for future conservation and sustainable use of this knowledge.

METHODS

Ethnobotanical fieldwork was conducted in 19 villages/townships in Qianxinan Prefecture between 2017 and 2018. Data were collected from the local Buyi people through semi-structured interviews and participatory observations. The informant consensus factor (FIC) and use reports (URs) were utilized to evaluate the consent of the current ethnoveterinary practices among the local communities, and 83 informants were interviewed during the field investigations. Plant samples and voucher specimens were collected for taxonomic identification.

RESULTS

A total of 122 plant species, belonging to 60 families and 114 genera, were recorded as being used in ethnoveterinary practices by the Buyi people. The most used ethnoveterinary medicinal plant (EMP) parts included the roots, whole plant, and bulb, and the most common preparation methods included decoction, crushing, and boiling. Some EMPs, such as Quisqualis indica and Paris polyphylla, have special preparation methods. The informant consensus factor (FIC) and use reports (URs) of the EMP species were analyzed. Twenty EMP species with the highest URs were noted as having particular importance in the daily lives of Buyi people in Qianxinan Prefecture.

CONCLUSION

In this study, we identified traditional ethnoveterinary knowledge of the medicinal plants among the Buyi communities in Qianxinan Prefecture. This knowledge has previously been limited to local vets, herders, and aged community members. Plants with important medicinal uses need to be validated phytochemically and pharmacologically in the future, to develop new alternative drugs for veterinary purposes.

Effects of Hydroxytyrosol against Lipopolysaccharide-Induced Inflammation and Oxidative Stress in Bovine Mammary Epithelial Cells: A Natural Therapeutic Tool for Bovine Mastitis

Background: Bovine mastitis is a growing health problem, affecting both welfare of dairy cattle and milk production. It often leads to chronic infections, disturbing the quality of milk and resulting in cow death. Thus, it has a great economic impact for breeders. Methods: In this study, we evaluated the protective effect of hydroxytyrosol—a natural molecule which is the major constituent of many phyto-complexes—in an in vitro model of mastitis induced by LPS (1μg/mL). Results: Our results showed that hydroxytyrosol (10 and 25 μM) was able to prevent the oxidative stress induced by LPS (intracellular ROS, GSH and NOX-1) and the consequently inflammatory response (TNF-α, IL-1β and IL-6). The protective effect of hydroxytyrosol is also related to the enhancement of endogenous antioxidant systems (Nrf2, HO-1, NQO-1 and Txnrd1). Moreover, hydroxytyrosol showed an important protective effect on cell functionality (α-casein S1, α-casein S2 and β-casein). Conclusions: Taken together, our results showed a significant protective effect of hydroxytyrosol on oxidative stress and inflammatory response in MAC-T cells. Thus, we indicated a possible important therapeutic role for hydroxytyrosol in the prevention or management of bovine mastitis.

Towards a bottom-up understanding of antimicrobial use and resistance on the farm: A knowledge, attitudes, and practices survey across livestock systems in five African countries

The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and inadequately controlled access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N = 110) and Kenya (N = 76), pastoralists keeping cattle, sheep, and goats in Tanzania (N = 195), and broiler farmers in Zambia (N = 198), and Zimbabwe (N = 298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralist households. Multivariate models showed that variation in knowledge, attitudes and practices is related to several factors, including gender, disease dynamics on the farm, and source of animal health information. Study results emphasize that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat antimicrobial resistance globally.

Antimicrobial resistant enteric bacteria are widely distributed amongst people, animals and the environment in Tanzania

Antibiotic use and bacterial transmission are responsible for the emergence, spread and persistence of antimicrobial-resistant (AR) bacteria, but their relative contribution likely differs across varying socio-economic, cultural, and ecological contexts. To better understand this interaction in a multi-cultural and resource-limited context, we examine the distribution of antimicrobial-resistant enteric bacteria from three ethnic groups in Tanzania. Household-level data (n = 425) was collected and bacteria isolated from people, livestock, dogs, wildlife and water sources (n = 62,376 isolates). The relative prevalence of different resistance phenotypes is similar across all sources. Multi-locus tandem repeat analysis (n = 719) and whole-genome sequencing (n = 816) of Escherichia coli demonstrate no evidence for host-population subdivision. Multivariate models show no evidence that veterinary antibiotic use increased the odds of detecting AR bacteria, whereas there is a strong association with livelihood factors related to bacterial transmission, demonstrating that to be effective, interventions need to accommodate different cultural practices and resource limitations.

Moringa Extract Attenuates Inflammatory Responses and Increases Gene Expression of Casein in Bovine Mammary Epithelial Cells

Bovine mastitis is a common inflammatory disease in the udder of dairy cows that causes economic loss to dairy industries. The development of alternative strategies, especially the utilization of natural products, e.g. Moringa oleifera, has gained a lot of interests. The objective of the current study was to investigate the protective effects of moringa extract (ME) in bovine mammary epithelial cells (MAC-T) in in vitro settings. Radical scavenging capacities and anti-inflammatory properties of ME were examined using lipopolysaccharide (LPS)-challenged MAC-T cells. ME showed significant radical scavenging activities. In addition, ME decreased reactive oxygen species produced by LPS in cells. ME also attenuated inflammatory cyclooxygenase-2 expression induced by LPS by down-regulating NF-κB signaling cascade. Moreover, ME ameliorated LPS-induced pro-inflammatory cytokines including tumor necrosis factor-, interleukin-1, and interleukin-6. Furthermore, ME up-regulated mRNA expression levels of heme oxygenase-1, NAD(P)H: quinone oxidoreductase-1, and thioredoxin reductase 1. Importantly, ME promoted differentiated MAC-T cells by increasing mRNA expression levels of α-casein S1, α-casein S2, and β-casein. In conclusion, ME has beneficial effects in bovine mammary epithelial cells through its anti-inflammatory, antioxidant, and casein production properties. Our study provides evidence that ME could be a good candidate for a feed supplement to decrease inflammatory responses due to bovine mastitis.

Plant Diversity and Ethnoveterinary Practices of Ethiopia: A Systematic Review

The systematic review was conducted on Ethnoveterinary Medicinal (EVM) plants from the two (integrated and pastoral) majorly known livestock production systems (LPS) of Ethiopia. A total of 48 documents pertinent to EVM significance were assessed from different sources using Google search engine and local university websites. Search outputs were screened using the developed inclusion criteria, and only 26 documents were selected. Descriptive analysis measures, Document Consensus Factor (DCF), and rank of the collected data were analysed using SPSS version 20 and Microsoft Excel. The result showed that females (33%), being below 40 years of age (27%), and educational level of above college (1%) healers participation was not significance. A total of 645 EVM plant species (from 133 families) were identified. Only 22 (16.54%) plant families were represented by one species. Leaf (47.8%) was the major plant part used to prepare remedies. The major administration route was oral route (58.2%). Blackleg 43 (0.188), diarrhea 25 (0.110), and wound 18 (0.079) were the most commonly treated livestock ailments. Solanaceae and Fabaceae were the frequently utilized EVM plant families in integrated and pastoral LPS, respectively. Croton macrostachyus (Bisana) and Solanum incanum (Embuay) were the most widely applied EVM plant species in integrated and pastoral LPS, respectively. Pastoral LPS were using higher number of specific EVM plants (DCF>0.5) compared to integrated LPS. Less than 40% (n< 10) of the collected documents were dealing with measurability and risk of toxicity, giving emphasis to indigenous plant and constraints of EVM plants use.

Ethnographic Decision Modeling to Understand Smallholder Antibiotic Use for Poultry in Guatemala

Widespread use of antibiotics is of concern due to the selection for resistant bacterial strains, which render life-saving antimicrobials ineffective. Smallholders in rural Guatemala rely on human antibiotics to treat their poultry, and in this article, I aim to understand why they do so. I incorporate Ethnographic Decision Modeling (EDM) to understand treatment behaviors. Results indicate that access and affordability in opportunity costs are barriers to seeking veterinary medicines for poultry. Access to veterinary medicine and education campaigns on poultry health are necessary to support the appropriate use of antimicrobials for backyard poultry.

Newcastle disease vaccine adoption by smallholder households in Tanzania: Identifying determinants and barriers

BACKGROUND

Food security is critical to achieving sustainable growth, poverty reduction, and political and economic stability. Livestock have the potential to improve the food security of smallholder households in developing countries, but livestock productivity is constrained by disease. The extent to which households adopt innovations such as vaccines impacts disease control; however, the behavioral and economic drivers underlying household decisions to adopt or forgo vaccination are not well understood. We address this gap with a study of adoption of Newcastle disease (ND) vaccines by chicken-owning households in Tanzania.

METHODS

A cross-sectional survey was administered to 535 households owning indigenous chickens in Arusha, Singida, and Mbeya regions in Tanzania. We measured potential predictors of ND vaccine adoption including knowledge, attitudes, and practices. Logistic regression was used to identify predictors correlated with three stages of household adoption: awareness of ND vaccines, previous vaccination, and recent vaccination (within four months) consistent with veterinary guidelines.

RESULTS

Eighty percent of households were aware of ND vaccines, 57% had previously vaccinated, and 26% had recently vaccinated. Knowing someone who vaccinated increased the odds of a household previously vaccinating [adjusted odds ratio (AOR): 1.32, 95% CI: 1.1-1.5]. Larger flock size was also associated with higher odds of previous vaccination (AOR: 1.03 for a one chicken increase, 95% CI: 1.01-1.05). Usage of traditional medicine decreased the odds of previously vaccination (AOR: 0.58, 95% CI: 0.36-0.95).

CONCLUSION

Our findings suggest that encouraging the flow of professional-level knowledge within the community by vaccine adopters is a strategy to increase vaccine adoption. Enhancing local chicken productivity through increased vaccine coverage would strengthen a key smallholder household resource for food and economic security.

Participatory epidemiology of endemic diseases in West African cattle - Ethnoveterinary and bioveterinary knowledge in Fulani disease control

Fulani pastoralists in Nigeria lack adequate access to good quality veterinary services and often resort to treating their animals themselves. There are several negative aspects to this, including poor treatment outcomes, misuse of veterinary drugs and subsequent resistance, and further barriers to good relations between pastoralists and veterinary services. A participatory epidemiology survey was undertaken in Fulani communities, to examine their ability to diagnose and treat bovine diseases. Qualitative participatory epidemiology techniques including semi-structured interviews, ranking and participant and non-participant observations were used for data collection. Quantitative analysis to match Fulani disease descriptions to veterinary diseases was done by hierarchical clustering and multi-dimensional scaling. A concurrent parasitological survey for soil-transmitted parasites, trypanosomiasis and tick-borne diseases was undertaken to validate results. Fulani pastoralists displayed high levels of ethnoveterinary knowledge and good clinical diagnostic abilities. Diseases considered important by pastoralists included: hanta (CBPP); sammore (trypanosomiasis); boro (foot and mouth disease), gortowel (liver fluke), dauda (parasitic gastro-enteritis with bloody diarrhoea) and susa (parasitic gastro-enteritis). The parasitology survey supported the participatory epidemiology results but also showed a high prevalence of tick-borne diseases that were not mentioned by pastoralists in this study. The use of "hanta" to describe CBPP is important as the accepted translation is liver-fluke (hanta is the Hausa word for liver). Gortowel and dauda, two previously undescribed Fulfulde disease names have now been matched to liver fluke and PGE with bloody diarrhoea. Fulani showed low levels of bovine veterinary knowledge with mostly incorrect veterinary drugs chosen for treatment. Levels of ethno- and bio-veterinary knowledge and their application within pastoralist livestock healthcare practices are discussed.

A two-month follow-up evaluation testing interventions to limit the emergence and spread of antimicrobial resistant bacteria among Maasai of northern Tanzania

BACKGROUND

In sub-Saharan Africa, efforts to control antimicrobial resistance (AMR) are aggravated by unregulated drug sales and use, and high connectivity between human, livestock, and wildlife populations. Our previous research indicates that Maasai agropastoralists-who have high exposure to livestock and livestock products and self-administer veterinary antibiotics-harbor antibiotic resistant Escherichia coli (E. coli). Here, we report the results of a public health intervention project among Maasai aimed at reducing selection and transmission of E. coli bacteria.

METHODS

Research was conducted in two Maasai communities in Northern Tanzania. Participants were provided with health knowledge and technological innovations to facilitate: 1) the prudent use of veterinary antibiotics (tape measures and dosage charts to calculate livestock weight for more accurate dosage), and, 2) the pasteurization of milk (thermometers), the latter of which was motivated by findings of high levels of resistant E. coli in Maasai milk. To determine knowledge retention and intervention adoption, we conducted a two-month follow-up evaluation in the largest of the two communities.

RESULTS

Retention of antimicrobial knowledge was positively associated with retention of bacterial knowledge and, among men, retention of bacterial knowledge was associated with greater wealth. Bacterial and AMR knowledge were not, however, associated with self-reported use of the innovations. Among women, self-reported use of the thermometers was associated with having more children and greater retention of knowledge about the health benefits of the innovations. Whereas 70% of women used their innovations correctly, men performed only 18% of the weight-estimation steps correctly. Men's correct use was associated with schooling, such that high illiteracy rates remain an important obstacle to the dissemination and diffusion of weight-estimation materials.

CONCLUSION

Our results indicate that dietary preferences for unboiled milk, concerns over child health, and a desire to improve the health of livestock are important cultural values that need to be incorporated in future AMR-prevention interventions that target Maasai populations. More generally, these findings inform future community-health interventions to limit AMR.

An ethnobotanical survey of medicinal and edible plants of Yalo Woreda in Afar regional state, Ethiopia

BACKGROUND

The Afar people inhabit the sub-arid and arid part of Ethiopia. Recurrent drought and invasive encroaching plants are taking out plants that have cultural importance, and threaten the biodiversity and the associated traditional knowledge. Thus, the aim of the current study is to conduct an ethnobotanical survey and document medicinal and edible plants in Yalo Woreda in Afar regional state.

METHODS

A cross-sectional ethnobotanical study was carried out in eight kebeles of Yalo Woreda from October 2015 to December 2016. One hundred sixty informants were selected using purposive sampling. The data on diseases, medicinal and edible plants were collected using semi-structure interview and group discussion. The statistical methods, informant consensus factor, fidelity level, and preference ranking were conducted to analyze the data.

RESULTS

One hundred and six plants were reported; gender and age differences had implication on the number of plants reported by informants. The knowledge of medicinal plants among informants of each kebele was not different (p < 0.5) and was not associated in particular with the religious establishment in the kebeles (informant*kebeles, Eta square = 0.19). Family Fabaceae was the major plant species, and shrubs (44%) were dominant plants reported. Leaf (52.94%) and oral (68%) were primary plant part used for remedy preparation and route of application, respectively. The plants with low fidelity values Indigofera articulata (0.25), Cadaba farinosa (0.22), Cadaba rotundifolia (0.19), and Acalypha fruticosa (0.15) were used to treat the category of diseases with high informant consensus value (0.69). Sixteen edible plants were identified that were consumed during wet and dry seasons. Balanites aegyptiaca, Balanites rotundifolia, and Dobera glabra were 'famine food' that were collected and stored for years.

CONCLUSION

People in Yalo Woreda are more dependent on natural resources of the area for their livelihood. The threat of climatic change and encroaching invasive plants on medicinal and edible plants affects the traditional use of plants in the Yalo Woreda. The conservation of the plants in the home garden and natural habitat and integration of edible plants into agroforestry development programs in sub-arid and arid regions has to be encouraged to conserve plants of medical and economic importance.